Abstract
BackgroundBlack individuals are far more likely than white individuals to develop end stage renal disease (ESRD). However, earlier stages of chronic kidney disease (CKD) have been reported to be less prevalent among blacks. This disparity remains poorly understood. The objective of this study was to evaluate whether the lower prevalence of CKD among blacks in early stages of CKD might be due in part to an inability of the MDRD equation to accurately determine early stages of CKD in both the black and white population.MethodsWe conducted a retrospective cohort study of 97, 451 patients seen in primary care clinic in Veterans Integrated Service Network 2 (VISN 2) over a 7 year period to determine the prevalence of CKD using both the Modification of Diet in Renal Disease (MDRD) Study equation and the more recently developed CKD Epidemiology Collaboration (CKD-EPI) equation. Demographic data, comorbid conditions, prescription of medications, and laboratory data were recorded. Logistic regression and quantile regression models were used to compare the prevalence of estimated glomerular filtration rate (eGFR) categories between black and white individuals.ResultsThe overall prevalence of CKD was lower when the CKD-EPI equation was used. Prevalence of CKD in whites was 53.2% by MDRD and 48.4% by CKD-EPI, versus 34.1% by MDRD and 34.5% by CKD-EPI in blacks. The cumulative logistic regression and quantile regression showed that when eGFR was calculated by the EPI method, blacks were as likely to present with an eGFR value less than 60 mL/min/1.73 m2 as whites. Using the CKD-EPI equation, blacks were more likely than white individuals to have stage 3b, 4 and 5 CKD. Using the MDRD method, the prevalence in blacks was only higher than in whites for stage 4 and 5 CKD. Similar results were obtained when the analysis was confined to patients over 65 years of age.ConclusionsThe MDRD equation overestimates the prevalence of CKD among whites and underestimates the prevalence of CKD in blacks compared to the CKD-EPI equation.
Highlights
Black individuals are far more likely than white individuals to develop end stage renal disease (ESRD)
We determined the prevalence of different stages of chronic kidney disease (CKD) using both the Modification of Diet in Renal Disease (MDRD) and CKD-EPI equations among the black versus white Veteran population in Veterans Integrated Service Network 2 (VISN 2), a large cohort consisting of all Veteran patients in central and western New York, and compared the use of two versus one serum creatinine in these equations
We studied the prevalence of different stages of CKD among blacks and whites in > 180,000 patients who were seen in primary care clinic at VISN2, using MDRD and CKD-EPI equations
Summary
Black individuals are far more likely than white individuals to develop end stage renal disease (ESRD). The objective of this study was to evaluate whether the lower prevalence of CKD among blacks in early stages of CKD might be due in part to an inability of the MDRD equation to accurately determine early stages of CKD in both the black and white population. The relationship of the racial prevalence of CKD to ESRD is complex, and not dependent solely on the prevalence of CKD These previous studies used a single serum creatinine measurement to determine the estimated GFR, the presence or absence of CKD, and its staging. The CKD-EPI equation was developed as a more accurate determination of the GFR [10] and has been found to correlate better with long term risk of end-stage renal disease and mortality in a middle aged population [11]. The objective of this study was to determine whether the lower prevalence of CKD among blacks in early stages of CKD might be due in part to an inability of the MDRD equation to accurately determine early stages of CKD in both the black and white population
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